Uterine Fibroids: Symptoms, Diagnosis and Treatment Options (video/podcast)

Uterine fibroids are non-cancerous growths that develop in the wall of a woman’s uterus. While they are not harmful, they can cause unwanted symptoms that affect quality of life and, in some cases, fertility.

In this video, Tresa Lombardi, MD, a gynecologist and minimally invasive surgery specialist at Scripps Clinic Rancho Bernardo, joins San Diego Health host Susan Taylor to talk about diagnosing and treating uterine fibroids.

Uterine fibroids are quite common, especially among women in their reproductive years. The cause of uterine fibroids is unknown, and their number and size can vary significantly. A woman may have just one fibroid or many, and they can be as small as a pea to as large as a grapefruit.

Depending on their size and location, fibroids may cause no symptoms or may lead to heavy menstrual bleeding, cramps, pelvic pain and frequent urination. 

“If fibroids are of a certain size, number or location, women can actually look and feel as if they're pregnant, with pressure and heaviness in the pelvis,” says Dr. Lombardi. “This is known as ‘bulk symptoms’ of uterine fibroids.”

Exceptionally large fibroids that push on nearby organs, such as the bladder or colon, may cause urinary and gastrointestinal symptoms, such as a sudden or frequent need to urinate, constipation, or painful bowel movements. 

Uterine fibroids are usually diagnosed with a pelvic ultrasound. In some cases, fibroids may also be detected during a routine pelvic exam if the doctor feels the growths or notices an enlarged uterus.

Although uterine fibroids are considered tumors, they are benign (non-cancerous) and will not develop into cancer over time. Small fibroids that cause no symptoms usually need no treatment. However, depending on a woman’s age when she is diagnosed, fibroids may grow or multiply. 

“Fibroids are driven by our natural female hormones, so it is not surprising that fibroids might enlarge over time or new fibroids develop. This is normal and expected until menopause,” explains Dr. Lombardi. “When women stop producing those female hormones, fibroids typically stay the same size or can even shrink.”

Uterine fibroid treatments depend on several factors, including a woman’s age, symptoms and future pregnancy plans. For example, a woman in her 30s may want to take action to prevent the fibroids from growing or multiplying, while a woman close to menopause may just choose to monitor them if symptoms are mild.

Future pregnancy plans are an important consideration because the size and location of fibroids can sometimes affect fertility or pregnancy.

Not all uterine fibroids affect fertility, but fibroids deep inside the uterus can push into the uterine cavity where a fetus will develop and grow. This can make becoming pregnant more difficult and, in some cases, may increase the risk of miscarriage. 

Fibroids are common during pregnancy and usually do not cause serious problems. In most cases, treatment is not needed as long as the baby is growing and developing normally.

Doctors generally recommend pursuing treatment for uterine fibroids when a woman is experiencing very heavy or prolonged bleeding with her period or having significant bulk symptoms.

Fibroids also can cause anemia, or a low red blood cell count. This can lead to symptoms, such as low energy, fatigue, shortness of breath during activity, and dizziness. 

“These are the scenarios where we would recommend going in to see your doctor to talk about treatment options,” Dr. Lombardi says.

There are a variety of treatments for uterine fibroids. Hormonal and non-hormonal medications can help manage symptoms such as bleeding and pelvic pressure, but they do not eliminate fibroids.

If medications are not effective or fertility is a concern, non-surgical or minimally invasive surgical procedures may be options. Non-surgical procedures include uterine fibroid embolization, which blocks the blood supply to the fibroids, and radiofrequency ablation, which destroys fibroids using heat. 

Surgery for uterine fibroids may include myomectomy, which removes the fibroids while leaving the uterus intact, or a complete removal of the uterus through a hysterectomy. 

“It really depends on the type of surgery a woman chooses, but we do try to employ a minimally invasive technique whenever possible,” says Dr. Lombardi. “Usually, women can go home the same day.” 

Dr. Lombardi encourages women who have symptoms that may be related to uterine fibroids to see their gynecologist.

“We have many more treatments now than in the past and we will help you determine the best care for your individual needs,” she says.

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